Mooney Peter D, Evans Kate E, Kurien Matthew, Hopper Andrew D, Sanders David S
Regional GI and Liver Unit, Royal Hallamshire Hospital, Sheffield, South Yorks, UK.
Eur J Gastroenterol Hepatol. 2015 Jun;27(6):692-7. doi: 10.1097/MEG.0000000000000359.
Coeliac disease (CD) has been linked to gastro-oesophageal reflux disease (GORD). Previous studies have demonstrated an increased prevalence of reflux in patients with CD. However data on the risk for CD in patients presenting with reflux are conflicting.
The aim of this study was to establish the prevalence of CD in patients with GORD and to elucidate the mechanisms for reflux symptoms in newly diagnosed CD patients.
Group A: patients who had undergone routine duodenal biopsy were prospectively recruited between 2004 and 2014. Diagnostic yield was compared with that of a screening cohort. Group B: 32 patients with newly diagnosed CD who had undergone oesophageal manometry and 24-h pH studies were prospectively recruited.
Group A: 3368 patients (58.7% female, mean age 53.4 years) underwent routine duodenal biopsy. Of these patients, 850 (25.2%) presented with GORD. The prevalence of CD among GORD patients was 1.3% (0.7-2.4%), which was not significantly higher than that in the general population (P=0.53). Within the context of routine duodenal biopsy at endoscopy (when corrected for concurrent symptoms, age and sex), reflux was found to be negatively associated with CD [adjusted odds ratio 0.12 (0.07-0.23), P<0.0001]. In group B, 34% of patients complained of reflux. On manometry, 9% had a hypotensive lower oesophageal sphincter and 40.6% had oesophageal motor abnormalities, with 25% significantly hypocontractile. On pH studies, 33% demonstrated reflux episodes.
The prevalence of undiagnosed CD among GORD patients is similar to that in the general population, and routine duodenal biopsy cannot be recommended. A significant number of patients with newly diagnosed CD were found to have reflux and/or oesophageal dysmotility on pH/manometry studies; this may explain the high prevalence of reflux symptoms in CD.
乳糜泻（CD）与胃食管反流病（GORD）有关。既往研究表明，CD患者中反流的患病率增加。然而，关于反流患者患CD风险的数据存在矛盾。
本研究旨在确定GORD患者中CD的患病率，并阐明新诊断的CD患者出现反流症状的机制。
A组：2004年至2014年期间前瞻性招募接受常规十二指肠活检的患者。将诊断率与筛查队列进行比较。B组：前瞻性招募32例接受食管测压和24小时pH值研究的新诊断CD患者。
A组：3368例患者（58.7%为女性，平均年龄53.4岁）接受常规十二指肠活检。其中，850例（25.2%）患有GORD。GORD患者中CD的患病率为1.3%（0.7 - 2.4%），并不显著高于普通人群（P = 0.53）。在内镜检查进行常规十二指肠活检的情况下（校正并发症状、年龄和性别后），发现反流与CD呈负相关[调整后的优势比为0.12（0.07 - 0.23），P < 0.0001]。在B组中，34%的患者主诉有反流。在测压方面，9%的患者食管下括约肌压力降低，40.6%的患者有食管运动异常，其中25%显著收缩功能减退。在pH值研究中，33%的患者出现反流发作。
GORD患者中未诊断出的CD患病率与普通人群相似，不建议进行常规十二指肠活检。在pH值/测压研究中，发现大量新诊断的CD患者有反流和/或食管运动障碍；这可能解释了CD中反流症状的高患病率。
